Khat Chewing Effect on the International Normalized Ratio in Patients with Mechanical Heart Valves under Warfarin Therapy

2020 ◽  
Vol 23 (11) ◽  
pp. 1487-1491
Author(s):  
Sultan Abdulwadou ◽  
Nouradden Noman Alja ◽  
Abdulwahab Omer Hussa ◽  
Khalid Mohammed A ◽  
Suliman Gafar Sali
Keyword(s):  
Heart Valves ◽  
Warfarin Therapy ◽  
International Normalized Ratio ◽  
Mechanical Heart Valves ◽  
Khat Chewing

Association between VEGFA gene polymorphisms and bleeding complications in patients maintaining therapeutic international normalized ratio

2019 ◽  
Vol 20 (9) ◽  
pp. 659-667 ◽  
Author(s):  
Jeong Yee ◽  
Woorim Kim ◽  
Byung Chul Chang ◽  
Jee Eun Chung ◽  
Kyung Eun Lee ◽  
...  
Keyword(s):  
Gene Polymorphisms ◽  
Bleeding Complication ◽  
Heart Valves ◽  
Warfarin Therapy ◽  
International Normalized Ratio ◽  
Mechanical Heart Valves ◽  
Bleeding Complications ◽  
Wild Type ◽  
Vegfa Gene

Aim: This study was designed to identify the possible effects of VEGFA polymorphisms on the occurrence of bleeding complications in patients with mechanical heart valves who have achieved therapeutic international normalized ratio (INR). Materials & methods: 13 SNPs of VEGFA were analyzed. Uni- and multi-variate analyses were conducted to identify associations between polymorphisms and bleeding complications. Results & conclusion: Patients with the CC genotype of rs35410204 had an approximately tenfold higher bleeding complication than those with the T allele. For rs866236, patients who had wild-type homozygotes showed an approximately 2.9-fold higher bleeding complication than C allele carriers. This study demonstrated that bleeding complications during warfarin therapy are associated with VEGFA polymorphisms in patients with mechanical heart valves.

scholarly journals Optimal target international normalized ratio for patients with mechanical heart valves

2004 ◽  
Vol 44 (5) ◽  
pp. 1142-1143 ◽  
Author(s):  
Johanna J.M. Takkenberg ◽  
John P.A. Puvimanasinghe ◽  
Lex A. van Herwerden
Keyword(s):  
Heart Valves ◽  
International Normalized Ratio ◽  
Mechanical Heart Valves ◽  
Optimal Target

scholarly journals Heartbeat: Warfarin therapy for mechanical heart valves

Heart ◽  
2017 ◽  
Vol 103 (3) ◽  
pp. 175-176
Author(s):  
Catherine M Otto
Keyword(s):  
Heart Valves ◽  
Warfarin Therapy ◽  
Mechanical Heart Valves

scholarly journals In-home Compared With In-Clinic Warfarin Therapy Monitoring in Mechanical Heart Valves: A Population-Based Study

2020 ◽  
Vol 4 (5) ◽  
pp. 511-520
Author(s):  
Martin van Zyl ◽  
Waldemar E. Wysokinski ◽  
Thomas M. Jaeger ◽  
Ana I. Casanegra ◽  
Bernard J. Gersh ◽  
...  
Keyword(s):  
Heart Valves ◽  
Warfarin Therapy ◽  
Therapy Monitoring ◽  
Population Based ◽  
Mechanical Heart Valves ◽  
Population Based Study

scholarly journals Incidence of thromboembolic complications in patients with mechanical heart valves with a subtherapeutic international normalized ratio

2009 ◽  
Vol 137 (1) ◽  
pp. 91-93 ◽  
Author(s):  
Francesco Dentali ◽  
Nicoletta Riva ◽  
Alessandra Malato ◽  
Giorgia Saccullo ◽  
Sergio Siragusa ◽  
...  
Keyword(s):  
Heart Valves ◽  
International Normalized Ratio ◽  
Mechanical Heart Valves ◽  
Thromboembolic Complications

Monitoring Warfarin Therapy with the International Normalized Ratio

1994 ◽  
Vol 28 (2) ◽  
pp. 242-244 ◽  
Author(s):  
Patricia A. Howard
Keyword(s):  
Ct Scan ◽  
Heart Valves ◽  
Warfarin Therapy ◽  
Medical Center ◽  
Current System ◽  
International Normalized Ratio ◽  
Bleeding Complications ◽  
Warfarin Dosage ◽  
Local Hospital ◽  
Traditional System

OBJECTIVE: To report a case of suboptimal warfarin monitoring. CASE SUMMARY: A patient with a history of rheumatic heart disease and a mechanical mitral valve was admitted to the local hospital complaining of left-sided weakness. At the time, she was receiving warfarin 5 mg/d. Upon admission her prothrombin time (PT) was 15 s. An initial computed tomography (CT) scan of the head was negative. On the basis of the initial findings, it was unclear whether the symptoms were caused by a cerebrovascular accident (CVA). The patient was transferred to the University Medical Center for a more thorough evaluation. The diagnosis of CVA was confirmed by a repeat CT scan seven days after the event. On the basis of the information obtained from the local hospital, it was determined that the initial PT of 15 s converted to an International Normalized Ratio (INR) of 1.5, which is below the recommended range for patients with mechanical heart valves. Prior to discharge, the warfarin dosage was increased to obtain an INR in the recommended range of 2.5–3.5. DISCUSSION: This case illustrates the problems that exist with the current system of PT reporting and the potential advantages of using the INR. Variations in the sensitivity of the thromboplastin reagents used to perform the PT may result in misinterpretation of the level of anticoagulation and errors in warfarin dosage adjustments. The potential for suboptimal anticoagulation is greatly increased in patients, such as the one reported here, who are having PTs performed by multiple laboratories. CONCLUSIONS: To maximize efficacy and minimize the risk of bleeding complications, warfarin therapy must be individualized and closely monitored. Standardization of PT monitoring through the use of the INR would significantly reduce the potential for suboptimal anticoagulation associated with the traditional system of reporting.

scholarly journals A Review of Warfarin Dosing and Monitoring

2018 ◽  
Vol 13 (1) ◽  
pp. 40-43 ◽  
Author(s):  
Khan Md Arif ◽  
Mohammad Ashiqur Rahman
Keyword(s):  
Venous Thromboembolism ◽  
Heart Valves ◽  
Warfarin Therapy ◽  
Thrombus Formation ◽  
Therapeutic Index ◽  
International Normalized Ratio ◽  
Major Surgery ◽  
Clotting Factors ◽  
Duration Of Treatment ◽  
Oral Anticoagulant Treatment

The anticoagulant drug warfarin is a vitamin K antagonist, coumarin derivative which inhibits the synthesis of clotting factors II, VII, IX, and X, as well as the naturally occurring endogenous anticoagulant proteins C and S. Warfarin is still considered the mainstay of oral anticoagulant treatment, it is a difficult drug to manage due to its narrow therapeutic index. An inappropriate management of patients can lead to subtherapeutic or supratherapeutic levels, increasing the risk of thromboembolic episodes or hemorrhagic episodes, respectively. Common indications for the use of warfarin include stroke prevention in atrial fibrillation, preventing thrombus formation in patients with heart valves and treatment of venous thromboembolism. When warfarin therapy is initiated for venous thromboembolism, it should be given the first day, along with a heparin product or fondaparinux. The heparin product or fondaparinux should be continued for at least five days and until the patient's international normalized ratio is at least 2.0 for two consecutive days. The international normalized ratio goal and duration of treatment with warfarin vary depending on indication and risk. Warfarin therapy should be stopped five days before major surgery and restarted 12 to 24 hours postoperatively. Bridging with low-molecular-weight heparin or other agents is based on balancing the risk of throm boembolism with the risk of bleeding.Faridpur Med. Coll. J. Jan 2018;13(1): 40-43

Low-Dose Anticoagulation in Chinese Patients with Mechanical Heart Valves

2005 ◽  
Vol 13 (4) ◽  
pp. 341-344 ◽  
Author(s):  
Xin-Min Zhou ◽  
Wei Zhuang ◽  
Jian-Guo Hu ◽  
Jian-Min Li ◽  
Jie-Feng Yu ◽  
...  
Keyword(s):  
Heart Valves ◽  
Low Dose ◽  
Mechanical Heart Valve ◽  
Major Complication ◽  
International Normalized Ratio ◽  
Thromboembolic Complication ◽  
Mechanical Heart Valves ◽  
Chinese Patients ◽  
Bleeding Events

The aim of this study was to provide guidelines for optimal anticoagulation in Chinese patients after mechanical heart valve replacement. A Carbomedics valve was implanted in 178 patients between July 2000 and July 2003. During follow-up, 22 bleeding events and 1 thromboembolic complication occurred. The linearized rates of bleeding and thromboembolism were 5.83% and 0.26% per patient-year, respectively. The linearized mortality rate was 0.79% per patient-year. The final mean international normalized ratio (INR) was 1.68 ± 0.38, however there was a significant variation between the early and late periods of follow-up. For Chinese patients with mechanical heart valves, bleeding was the major complication rather than thromboembolism. Low-dose anticoagulation (international normalized ratio 1.4–2.0) could markedly decrease bleeding and effectively prevent thromboembolism. As the INR was most unstable in the first postoperative month, re-examination of patients in this period is critical.

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